The free clinic in town is located in the center plaza square. It is government-run and financed by the Department of Health. It provides a majority of the town’s medical care, especially for the very poor who cannot afford the private hospital. The clinic is staffed by two local “nurses” and a general physician. (A generalist has finished medical school, but is not required to complete an internship or residency). The building is made up of three rooms: a waiting area with 3 benches, a large room sectioned off with curtains for “private visits” and a small windowless room for labor and delivery.
I was walking through town, on my way to an afternoon run when I was called for an emergency in the Centro de Salud. A woman had just given birth and noted to have a cervical laceration that the generalist could not repair. I ran into the building and was greeted by a waiting room full of women, I suspect, waiting for the delivery. One of the nurses ushered me towards the back. The birthing room was dark and small, barely accommodating four people. In the center, an exam table with stirrups from the 1960s stood under the only spotlight. There was one sink in the corner, running water from the lake, and a bar of soap. The patient was appropriately exhausted after delivery a 9+lb infant. The father was pacing around in the back corner, alternating his gaze from the chubby baby in the basket and his wife. The two nurses were buzzing around the physician and patient, following orders and assessing the patient’s moans and cries.
I was shocked at the situation and immediately noted the public health violations. The nurses were not wearing gloves. The physician was wearing gloves (they cannot afford sterile gloves) but was touching everything in the room. The lap tapes were strewn about the tables and floor, and the instruments were cleaned with soap and water between uses.
By the time I finished repairing the cervical laceration, the patient had had a 1L blood loss. I packed the vagina and recommended that they send the patient to the public hospital in Solola (2 hours away) to be monitored and for a possible blood transfusion. The family was reluctant, because of cost, but they were far more fearful of the alternative.